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RADIOLOGY: ABDOMEN: Case# 33007: RPF VS. LYMPHOMA?. This is a 76 year old male who has had an ultrasound showing an apparent infiltrative process around the right kidney. This examination is done to further evaluate this lesion and to determine if it is related to a right renal mass. There is a very extensive mass surrounding the right kidney and extending into the suprarenal region obscuring the adrenal gland. This mass also involves the retroperitoneal space, especially to the right of the aorta and extends inferior to the kidney. This abnormal infiltrative mass is slightly heterogeneous but is relatively low signal on T1 weighted images just slightly more intense than renal parenchymal. On T2, it is heterogeneous but hyperintense compared to renal parenchyma. Following contrast injection, there appears to be enhancement within the abnormal tissue itself, somewhat greater than the enhancement of the kidney. The right kidney itself shows no definite renal mass. However, a small lesion could perhaps be missed because of the somewhat poor quality of the images. The right kidney also shows no evidence of hydronephrosis. This is despite engulfment of both the kidney and the renal pelvic region by this abnormal mass. The left kidney is unremarkable. The liver shows no definite signs of metastases. The inferior vena cava is displaced anteriorly and is narrowed by the mass, especially in the suprarenal region. However, there is no definite vena cava thrombosis. The upper abdominal aorta is unremarkable. There is a distal abdominal aortic aneurysm measuring approximately 4 cm in diameter at the most distal level. The entire abdominal aorta, however, was not examined. There is a single focal lesion in an upper lumbar vertebral body, probably L2 measuring approximately 2 cm in diameter that is low signal on T1 and high signal on T2 and is consistent with a vertebral metastasis. The remaining abdominal structures are unremarkable. There is a small right pleural effusion.

Peter Anderson
abdomen, radiology